Cazzaniga Simone, De Ponti Lucia, Baratelli Giorgio Maria, Francione Salvatore, La Vecchia Carlo, Di Landro Anna, Carugno Andrea, Di Mercurio Marco, Germi Lerica, Trevisan Giampaolo, Fenaroli Mirko, Capasso Claudia, Pezza Michele, Dri Pietro, Castelli Emanuele, Naldi Luigi
Centro Studi GISED, Bergamo, Italy.
Department of Dermatology, Inselspital University Hospital of Bern, Switzerland.
Dermatol Reports. 2022 Jul 14;15(1):9500. doi: 10.4081/dr.2022.9500. eCollection 2023 Mar 7.
Smartphone apps may help promoting the early diagnosis of melanoma. The reliability of specialist judgment on lesions should be assessed. Hereby, we evaluated the agreement of 6 young dermatologists, after a specific training. Clinical judgment was evaluated during 2 online sessions, 1 month apart, on a series of 45 pigmentary lesions. Lesions were classified as highly suspicious, suspicious, non-suspicious or not assessable. Cohen's and Fleiss' kappa were used to calculate intra- and inter-rater agreement. The overall intra-rater agreement was 0.42 (95% confidence interval - CI: 0.33-0.50), varying between 0.12-0.59 on single raters. The inter-rater agreement during the first phase was 0.29 (95% CI: 0.24-0.34). When considering the agreement for each category of judgment, kappa varied from 0.19 for not assessable to 0.48 for highly suspicious lesions. Similar results were obtained in the second exercise. The study showed a less than satisfactory agreement among young dermatologists. Our data point to the need for improving the reliability of the clinical diagnoses of melanoma especially when assessing small lesions and when dealing with thin melanomas at a population level.
智能手机应用程序可能有助于促进黑色素瘤的早期诊断。应评估专家对病变判断的可靠性。在此，我们评估了6名年轻皮肤科医生在接受特定培训后的一致性。在相隔1个月的2次在线会议期间，对一系列45个色素性病变进行了临床判断评估。病变被分类为高度可疑、可疑、不可疑或不可评估。使用科恩（Cohen）kappa系数和弗莱iss（Fleiss）kappa系数来计算评分者内部和评分者之间的一致性。评分者内部的总体一致性为0.42（95%置信区间 - CI：0.33 - 0.50），单个评分者之间的一致性在0.12 - 0.59之间。第一阶段评分者之间的一致性为0.29（95%CI：0.24 - 0.34）。当考虑每个判断类别的一致性时，kappa系数从不可评估的0.19到高度可疑病变的0.48不等。在第二次评估中也获得了类似的结果。该研究表明年轻皮肤科医生之间的一致性不尽人意。我们的数据表明，尤其是在人群层面评估小病变和处理薄黑色素瘤时，需要提高黑色素瘤临床诊断的可靠性。
